The Growing Case for Precision Medicine
Precision medicine, also known as personalized medicine, is an emerging science that is focused on prevention of a disease whereby treatments are prescribed based on an individual’s genetic traits, environment, and lifestyle. This treatment finds its usefulness in the treatment of various diseases, especially cancer and several research institutions are conducting clinical trials to make drugs that can be tailored to suit each individual.
So, how is Precision Medicine actually useful?
Treatment of Cancer is one of the areas in which precision medicine has made a significant headway as new therapies are being researched to target the cancerous cells and make its life shorter. When a patient is diagnosed with cancer, for example, lung cancer, the doctor usually takes a sample of the patient’s tumor and sequences the patient’s genes to study and understand the genetic factors that have caused cancer. We know that mutations in the genes can cause cancer but these mutations could be acquired too, that is they could develop over time due to environmental and lifestyle factors. Once these acquired mutations have been identified, doctors can prescribe customized drugs or precision medicine that targets only these cells with that mutation. This is very different and more beneficial than the existing chemotherapy which destroys both the cancerous as well as healthy cells. Also, it is healthier for patients who receive such treatments as the patients receiving treatments targeted specifically at cancer cells tend to experience fewer side effects, feel better, and recover more quickly.
The traditional methods of curing a disease are largely reactive whereby the treatment begins only after the onset of a disease. But certain diseases, such as diabetes and Alzheimer’s disease do not have a permanent cure because the underlying cause of these diseases and the genetic factors involved are not yet fully understood. Consequently, the drugs that are devised for such diseases are not very effective for everyone because doctors treat patients with the same disease using same drugs and the same dose.
Precision medicine, on the other hand being customized based on a patient’s unique genetic makeup, overcomes the limitations of traditional medicine and strongly improve patient outcomes. In fact, precision medicine is allowing healthcare providers to prescribe safe drugs that are more effective, without major side effects, provide proactive preventive cure rather than reactive cure, forestall the progression of a disease, provide the right treatment to the right patient at the right time with the right outcome, eliminate unnecessary treatments and costs associated with them.
The advances in genome sequencing technologies have resulted in lowering of costs associated with genome sequencing and this has allowed more and more patients to conduct their genetic tests.
In the recent past, some of the developed nations have launched big initiatives in precision medicine. In 2012, UK launched the 100,000 Genomes project, which is led by the National Health Service (NHS) in collaboration with top scientists and the pharma industry of the country. This project aims at sequencing 100,000 genomes, including cancers, rare diseases, and pathogens. In 2015, the U.S.A. launched a similar initiative focusing on non-communicable diseases with a firm belief and vision that precision medicine will shape the future of medicine.
How is Malaysia adapting to Precision Medicine?
According to Professor Rahman Jamal, of UKM Medical Molecular Biology Institute (UMBI), Universiti Kebangsaan Malaysia, if Malaysia wants to be an early adapter to precision medicine, they will need to champion the cause and build good sequencing facilities, with skillful and knowledgeable geneticists, scientists and bioinformaticians. In fact, they have started with genome sequencing on patients with genetic disorders, certain rare diseases, and cancer and is making good progress.
An article published by Professor Rahman Jamal in the Asia-Pacific Journal of Mol. Medicine 2017, 7(1):1, cites the following applications of Precision medicine.
- Risk Assessment – By performing genetic testing, it is possible to know a person’s risk or tendency to develop a disease at a later stage. For example, the BRCA1/2 gene testing helps identify those at high risk of developing breast cancer.
- Prevention of Diseases – As genome sequencing helps reveal one’s predisposition to disease, it is possible to take preventive steps to prevent the disease. A good example is the detection of genetic variants or polymorphisms, which confer a high risk of non-communicable diseases such as diabetes.
- Treatment of Rare Diseases – Personalized medicine is useful in pharmacogenetics which includes screening for HLA-B*1502 polymorphism before commencing Tegretol for patients with epilepsy. Patients who have this genetic variant will have a high risk of developing Stevens Johnson syndrome.
The Role of Technology
I believe that technology has a key role to play in ensuring the success of Precision Medicine. The large volume of genetic data and samples which can help in the research could be analyzed quickly and effectively using technology. Through the appropriate integration of electronic health records in patient care, doctors and researchers can access the medical data more efficiently. The patient-reported and EHR-based data can be utilized to improve the precision of treatments.
Precision Medicine has just to make a positive impact in the health industry, and its future looks very promising. In the coming years, it will be an even more powerful weapon against and many of the rare diseases. But to get to that stage requires a lot of efforts and collaboration between governments, insurance providers, pharmaceutical companies, scientists, and doctors to conduct more sophisticated experiments and come up with effective tailor-made drugs.